Scientific Name(s): Hamamelis virginiana L.
Common Name(s): Cortex Hamamelis, Folium Hamamelis, Hamamelis, Hamamelis water, Magician's rod, Snapping hazel, Spotted alder, Tobacco wood, White hazel, Winter bloom, Witch hazel
Drug class: Topical astringents
Use
Hamamelis preparations are commonly used for dermatological conditions, including diaper-related dermatitis; however, clinical studies supporting these uses are generally lacking. Witch hazel has been evaluated for uses including analgesic, antiseptic, antioxidant, and antitumor activity.
Dosing
Topical — Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug. Rectal — Suppositories containing witch hazel contain from 0.1 to 1 g/dose. Oral — not recommended.
Contraindications
Internal use of extracts is not recommended because of the tannin content.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
Allergic contact dermatitis has been reported from topical applications.
Toxicology
Although extracts of witch hazel are available commercially, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined.
Scientific Family
- Hamamelidaceae (witch hazel)
Botany
Witch hazel grows as a highly branched deciduous bush or small tree, often reaching approximately 6 m in height. The plant is indigenous to the Atlantic coast and found in damp woods throughout most of North America. Its broad, toothed leaves are ovate, and the threadlike golden-yellow flowers bloom in the fall. Brown fruit capsules appear after the flowers and, when ripe, eject 2 seeds away from the tree. The dried leaves, bark, and twigs are used traditionally. A synonym is Hamamelis macrophylla.
History
Witch hazel is a widely known plant with a long history of use in the Americas. The plant, including the crude leaf and bark, is used in a variety of forms; fluid extracts, poultice, and commonly as witch hazel water. The latter, also known as Hamamelis water or distilled witch hazel extract, is obtained from recently cut, partially dormant twigs. This plant material is soaked in warm water, followed by distillation and the addition of alcohol to the distillate. Witch hazel water is the most commonly found commercial preparation, usually kept in most homes as a topical cooling agent or astringent.
Traditionally, witch hazel was known to native North American people as a treatment for tumors and eye inflammations. It was used internally for hemorrhage. Other uses include treatment of hemorrhoids, burns, cancers, tuberculosis, colds, and fever. Preparations have been used topically for symptomatic treatment of itching and other skin inflammation, and in ophthalmic preparations for irritation.
Chemistry
H. virginiana bark primarily contains polyphenols, including tannins, phenolic acids, and flavonoids. At least 27 phenolic constituents have been identified using high-pressure liquid chromatography, liquid chromatography, and mass spectrometric methods. Methods for quantifying gallic acid, hamamelitannin (approximately 1.5% in leaves and up to 65% in bark), and the proanthocyanidins have been described. The gallotannins are heat labile. Because witch hazel water is a steam distillate of the extract, it does not contain tannins.
Other components include kaempferol, quercetin, chlorogenic acid isomers, and hydroxycinnamic acids. The volatile oil contains small amounts of safrole and eugenol as well as numerous other minor components, such as resin, wax, and choline.
Uses and Pharmacology
Antimicrobial
Animal data
In vitro studies have shown antibacterial properties of the plant extract (both leaf and bark) versus Escherichia coli, Staphylococcus aureus (including resistant strains), Bacillus subtilis, and Enterococcus faecalis. Activity against periodontopathic bacteria has also been reported.
Clinical data
Clinical trials are lacking. In healthy volunteers, a distillate of Hamamelis demonstrated weak topical antibacterial activity. Antiviral effects in herpes labialis were reported in a clinical trial of Hamamelis ointment compared with placebo; however, a reduction in inflammation was only noted on day 8.
Dermatological uses
Hamamelis preparations are commonly used for dermatological conditions in several countries; however, quality clinical studies supporting these uses are lacking.
Animal data
Animal models have been used to demonstrate astringent and hemostatic properties of the plant extracts. At lower concentrations, Hamamelis extracts decreased cell permeability, while at higher concentrations, a healing effect was produced by influence on proteins and colloidal tissue. Fluid extracts administered parenterally to rabbits were also vasoconstrictive, reducing suppuration in purulent skin.
Clinical data
Older, uncontrolled clinical studies evaluated the efficacy of Hamamelis preparations in anorectal conditions (eg, hemorrhoids). Equivalence with bismuth subgallate has been shown.
In healthy volunteers, topical extracts of Hamamelis reduced the erythema consequent to ultraviolet (UV) and chemical irritation to a lesser extent than hydrocortisone 1%, but greater than the antihistamine (dimethindene). In an open-label study, Hamamelis 6.25% ointment was effective in reducing symptoms related to minor skin injuries, diaper dermatitis, and localized inflammation of the skin in children.
Limited clinical studies exist on the use of Hamamelis ointment in managing eczema. Results of these studies are equivocal, with some reporting no difference in Hamamelis ointment over placebo. Polyphenols from Hamamelis have been used in collagen sponges in studies on long-term wound healing.
Other uses
Hamamelis cream has been used as an analgesic following episiotomy or perineal trauma following childbirth; no difference in pain relief or additional analgesic use was observed between use of witch hazel and an ice pack.
Antioxidant properties have been described for Hamamelis extracts. This line of study is in the context of antiaging dermatological preparations; however, the activity of witch hazel appears lower compared with other preparations.
H. virginiana mouthwash was much less effective at reducing tooth biofilm and plaque compared to other agents tested in a 4-week randomized blind study (n=50). Chlorhexidine gluconate, cetylpyridinium chloride, and triclosan reduced mean plaque index values significantly (range, 66% to 69% at baseline to 13% to 32%), whereas H. virginiana produced a much smaller reduction (71% to 59%).
Fractions of Hamamelis extracts have been evaluated in vitro for antitumor and UV protective activity.
Prevention of purpuric lesions associated with tattooed skin by incorporating witch hazel into tattoo ink has also been suggested in a case study.
Dosing
Topical
Steam distillates of Hamamelis are used diluted (1:3 with water) or undiluted, and in semisolid preparations at 5% to 10% of crude drug.
Rectal
Suppositories containing witch hazel contain 0.1 to 1 g/dose.
Oral
Not recommended.
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.2
Interactions
None well documented.
Adverse Reactions
Although tannins are not usually absorbed following oral administration, doses of Hamamelis extracts 1 g have caused nausea, vomiting, or constipation. Hepatic damage may occur if the tannins are absorbed to an appreciable extent. Witch hazel water is not intended for internal use. Teas can be brewed from leaves and twigs commercially available in some health food stores, but their safety is unknown.
Allergic contact dermatitis has been reported, and cross-sensitivity to Compositae plants (including arnica and chamomile) is possible.
Toxicology
Information is generally lacking. Aqueous extract of Hamamelis leaves were not carcinogenic to rodents when administered subcutaneously. Although the volatile oil contains the carcinogen safrole, it is found in much smaller quantities than in sassafras. Extracts of witch hazel are available commercially; however, it is not recommended that they be taken internally because the toxicity of the tannins has not been well defined. Witch hazel accounted for 6% of reported adverse events to the California Poison Control System from January 1997 to June 1998.